Nursing Head Division at Eka Hospital

Population ageing arises in Indonesia related to demographic effects. Indonesia on the  threshold of population ageing. The number of elderly is estimated by the year 2045 about 20%  of the total population. In order to cope with the growing need for healthcare service. It is  essential to develop affordable, unobtrusive and easy-to-use healthcare solutions. Nurse leader  rounds were defined as one of the systematic process.

There are more than 2000 hospitals both type A, B, C and type D which are spread in almost  all corners of Indonesia. Data from Indonesia Ministry of Health by the year 2017 stated that  there are only 8 hospitals that provide geriatric special services. Health services for geriatric  patients are generally equalized with adult patients. Some hospital concepts that use a  clustering system actually only separates them in accordingly to the type of disease. So that  geriatric patients who get services at the hospital do not get services according to their age. At  a glance, diseases and health problems experienced by geriatric patients are the same as adult  patients in general. It is often forgotten that geriatric patients enter a degenerative period, in  which complaints arise due to reduced bodily functions. This condition certainly requires a  different and more in-depth service from the treating medical officer.

Geriatric patients with degenerative syndrome need extra care. This needs to be equaled with  the nurse's ability to provide nursing care in accordance with the needs of geriatric patients.  Several conditions related to patient services in hospitals raise a high level of complaints.  Geriatric patients often receive dissatisfaction with the nursing services provided. If caring is  put as basic treatment consistently then the geriatric patient's trust and satisfaction will  increase. Seeing this condition a nursing leader has an important role in improving the quality  of service in the unit he leads. Development and innovation are carried out is with nursing  leaders rounds.

Nursing Leader Round is a structured activity carried out by nurse leaders in an effort to create  a safe, comfortable and quality service environment. This activity is a form of supervision of  the nurse leader for ensuring the services provided by nursing staff are appropriate to help  meeting the needs of patients. This activity invites the nurse leader to come down directly and  interact with patients. So get fast feedback from patients and families on service problems. This  is reinforced by the literacy from Hospital Consumer Assessment of Healthcare Providers and  Systems (HCAPS) that the optimal Nursing Leader Round can increase understanding of  patient safety, identify patient needs and expectations of service and increase patient  satisfaction (Katelsen, Lyn., Cook, Karen., Kennedy, Bekki, 2014., Carroll, Susan MS. &  Timothy M. Carrigan, 2016) . Actually this positive effect of Nursing Leader Round can  improve the geriatric care on hospital.

Graphic 1 The relationship between the implementation of the Nursing Leader Round of patient  satisfaction according to HCAHPS (LaBorde, Stephanie,. 2018)

Based on the graph above, the implementation of Nursing Leader Rounding held in May, it  can be conclude that patient satisfaction increased, especially related to communication of pain  experienced by patients arose up to 71.40% and communication education of patient therapy  increased up to 98.30%. Though these results have not been continuous monitoring and  evaluation. However, the implementation of Nursing Leader Rounding result description is as  a significant impact on patient satisfaction at a hospital.

Nurse leader role in giving service is not just as a managerial service manager. Considering the  basic concern of nurses is caring, nursing care becomes the role and function that must be  carried out. A close relationship with this role and function for geriatric services in hospitals is  the provision of assistance in geriatric nursing care to be carried out optimally. The nurse leader  cannot overlook whenever it is related to existing services. In the past decade complaints have  arisen regarding to nursing care caused by patients and families ignorance the nurses who give  patient care. The presence of the nurse leader increases the nurses' caring for the patients  treated.

The implementation of Nursing Leader Round where the nurse leader conducts direct  management beside the patient's bed, provides an optimal role and function description of the  nursing staff. This concept has the potential contribution to the develop scientific of leadership  and nursing skills. Nurse leaders who have the competence and ability to process information  during the Nursing Leader Round allow savings in geriatric service costs at the hospital. The  nurse leader can optimize the role and function of the implementing nurse so that the treatment  process from entry to optimal planned discharge.

Optimal implementation of Nursing Leader Round has a positive impact on existing nursing  services. This impact is not only felt by patients and families, but staff and services in general  will also get a good impact. Positive impacts that can be felt by patients and families include  1) Patients and families know the nurse who is responsible for the therapy program. 2)  Patients and families easily identify who is treating. 3) Patients and families have easy access  the information and education related to the care program they are undergoing. 4) Patients  and families can monitor the results of supporting examinations and the progress of the  treatment process achieved. 5) Patients and families can monitor compliance with care  standards.

Other impacts of Nursing Leader Round were also felt by the existing nursing team. This  implementation is closely related to the supervisory function of the nursing leadership. With  direct supervision to patients motivate nurses to maintain nursing services according to  standards. Nursing leader can give impact 1) Providing supervision and support to junior  nursing staff. 2) Identifying individual and team training and development needs as a whole.  3) Improve communication about patient care and staff performance in two directions with  the nurse leader. 4) Give ease in carrying out the role of coordinator and manager of nursing.  It also supports identification of patient problem solving and focused on information and  communication to optimize patient care.

Nursing Leader Round allows patients, family, nursing teams and other health professionals  to focus on communicating and sharing information. Matters relating to the development of  the patient's condition can be immediately communicated and determined the solution to  optimize existing services. This concept provides important information for nurses on duty  to be able to coordinate, manage and caring patient. They provide tolls to monitor the  standard of care, the condition of the practice area and the environment that supports the  service. Nursing staff need to know the goals of the Nursing Leader Round and understand  the potential benefits that might be obtained.

Professional nurses tend to have concerns about the length of time that Nursing Leader  Round might be taken. Ideally, activities should be sententious. Because the aim is to identify  the patient's problems in general, nursing problems and intervention plans that can be carried  out by the nursing team. According to the explanation above, it can be formulated a concept  of developing geriatric services from nursing leaders through Nursing Leader Round. The  formulation of this concept can be learned from the following figure:

Figure 1. Nursing Leader Round Model in Geriatric service

Nursing Leader Round model allows the concepts of identification related to clear structure  mapping by identifying the teams involved, the place and time of implementation. This  model allows the structure to identify the tools need and infrastructure in geriatric patient  care. The above process describes the parts of the service that must be improved. The  ongoing process touches all aspects of service management. The final result of the ongoing  process is service improvement and increased satisfaction from geriatric patients.

Nursing Leader Round which is carried out with a consistent structured can help to reduce  the number of errors in the service of geriatric patients. This paradigm shift in the provision  of nursing services using the Nursing Leader Round concept had a significant impact on  clinical services. Effective leadership in nursing services not only on the managerial system  but also the interactions between nurse leaders and patients, especially geriatric patients will  reduce the proportion of morbidity and mortality. Patient services are becoming more  controlled, communication regarding to services is also clearer.

Geriatric care arising because the service supported by the Nursing Leader Round was able  to increase collaboration among care giver professionals. The nurse leader can also directly  examine the cognitive conditions of both the geriatric patient and the patient's family. The  description of cognitive conditions that can be captured directly by the leadership of nursing  become basic preparation of service methods that will be provided. The supervisor function  of the nurse leader also becomes more optimal. This can reduce the number of complaints  from patients and families. And increase positive relations and trust in the services provided.

On one side, we are offered to solutive concept to improve specific nursing services for  geriatric patients who have more complex needs than patients in other age ranges. The other  side nurse leader are quite busy managing administrative matters related to managerial roles.  This is a very potential challenge that makes nursing leaders difficult to be able to activate  directly with patients. While as a nursing leader must be responsible for managing nursing  care as well. This article is expected to be a spirit in the hospital.